How Sexual Desire Works- The Enigmatic Urge

by Frederick Toates

  A tendency to repeat earlier trauma

  The ‘tendency to repeat trauma’ represents an unexpected and counter-intuitive role of arousal and learning in the sexual behaviour of some individuals.

  What is it?

  A significant percentage of those who display unusual sexual behaviour were subject to intense stress as children, for example in the form of abuse. Such exposure can later create a tendency for people to put themselves back into situations similar to that which caused the initial trauma (Apter, 2007; Chaney and Chang, 2005; van der Kolk, 1989). The phenomenon of trauma-seeking is widespread, not confined to childhood exposure.

  Two examples that are not necessarily related to sexual behaviour might point to a common underlying process. Consider the phenomenon of ‘combat addiction’. Sufferers appear to crave danger to ‘get the adrenalin flowing’ and create a psychological state similar to that of the original trauma. Some use the terms ‘sexual trip’, ‘orgasmic’ and ‘orgiastic’ to describe the battlefield (Apter, 2007). Therefore, re-enactments of the original setting of the trauma are sought, with the consequence of a brief improvement in the sense of well-being. For example, one Vietnam War veteran would visit the oriental part of an American town and occasionally find men looking like Vietnamese with whom he could pick a fight. This made him feel alive again and following the fights a sense of calmness prevailed. It would just temporarily lift his loneliness, anger and anxiety.

  The bizarre case of Dr Shipman

  The British doctor and serial killer Harold Shipman appears to exemplify the ‘tendency to repeat trauma’. Shipman represents a slight digression in the story-line but one that might have an important relevance. While still a young man, Harold watched as his chronically ill mother derived pain relief from regular injections of morphine given by a doctor (Whittle and Ritchie, 2004). At age 17 years, Harold was present at her death, which devastated him. His reaction was to go out on a strenuous run, the consequences of which might have had a soothing effect similar to that found in the aftermath of his killings.

  Some years later, after qualifying as a doctor, he developed an addiction to pethidine, a drug similar to morphine. Shipman then proceeded to kill his elderly, particularly women, patients by lethal injections of morphine, under circumstances similar to the death of his own mother. He has been described as ‘addicted to the adrenalin rush’ and searching for the ultimate but elusive ‘super-high’, revealed in a rapidly escalating frequency of murders towards the end. Whether there was a sexual motivation to his killing is a topic of speculation (Whittle and Ritchie, 2004), the answer to which went to Shipman’s grave with him.

  According to the interpretation of Hickey (2010, p. 171), Shipman was not a lust killer and felt that his victims: ‘would not leave him again without his permission’. Furthermore (p. 171): ‘By killing his female patients he controlled the when and how, two issues that he had no control over when his mother died.’ Police, lawyers and psychiatrists have failed to find a rational motive behind Shipman’s killings; what was it, if not money, revenge or sexual arousal? Perhaps rational analysis led investigators to pose the wrong questions. Shipman might have been simply drawn to experience a motivationally irresistible event of very high arousal value associated with temporary closure and tension relief. Whatever, it would seem that Shipman illustrates an addictive feature of how behaviour can be determined and one that could also play a role in some unambiguously sexually motivated behaviour.

  Link to sexual behaviour

  There are various forms that re-exposure to trauma can take. A number of children who were sexually abused go on to become sexual abusers1 or rapists, while many engage in self-harm. In one sample of women who described themselves as sex or love addicts, some 50 per cent had experienced either child sexual abuse or exposure to pornography (Corley and Hook, 2012). Children who have been physically abused sometimes appear to try to provoke attack or emulate their abuser by attacking other children, thereby gaining a modicum of control (Green, 1985). Boys tend to grow up to identify with the abuser and exhibit violence, whereas girls tend to become the passive victims of male violence (van der Kolk, 1989). Boy victims often go on to become abusive husbands. Some men seek re-enactment of their trauma through visiting porno web-sites exhibiting similar events (Chaney and Chang, 2005). Boys who practise autoerotic asphyxiation (‘self-strangling’) appear to have a history of trauma, sometimes specifically of being strangled (Friedrich and Gerber, 1994).

  Girls who were abused have a relatively high later probability of engaging in sadomasochistic sex, prostitution or in other risky sexual activities (Green, 1985; Southern, 2002). For example, Rosemary West who, it was speculated, had been abused as a child, showed extreme sexual precocity, perverse sexuality and engaged in prostitution as well as becoming a sexually linked serial killer (Sounes, 1995). The occasional hostage comes to desire sex with her hostage-taker. Rape victims sometimes bond with their rapist (Ellis, 1989). To the dismay and frustration of police and social workers alike, battered wives often find their path back to their tormentors.

  The Victorian English writer ‘Walter’ reports that his first sexual experience happened between the ages of 5 and 8, when his nursemaid would hold his penis, a painful and traumatic experience, followed by her soothing him (Walter, 1995). Walter developed an insatiable appetite for sex.

  Consider also an American businesswoman, Laura, who started to use pornography at age 11 following sexual abuse (Maltz and Maltz, 2010, pp. 41 and 207):

  My two older brothers got into my dad’s pornography. They showed me the pictures and read me the stories, and then did to me what they had seen and heard. I became their learning tool. It may sound strange but later on I would sneak into their rooms and look through the magazines by myself. I developed a fascination with stories of women who felt threatened in sex. I had a nightly routine of masturbating to the porn. It gave me an escape from the reality of what my brothers were doing to me and enabled me to get to sleep. I used pornography this way even after they stopped abusing me.

  I’ve mostly been drawn to written porn about risky sex in which a woman is weak and physically threatened. It’s pretty clear that my attraction to this scenario has something to do with how powerless I felt when my brothers molested me when I was a young girl.

  Laura’s situation was possibly transformed from aversive to attractive because of the control that she gained subsequently with the pornography. The common element of high arousal was carried over between situations.

  How do we explain it in terms of the brain?

  This phenomenon seems to be a specific example of a general principle described by Sigmund Freud in Beyond the Pleasure Principle under the name of the ‘compulsion to repeat’. He suggested that it represents an attempt to gain mastery of the situation, which overrides the tendency of the body to seek pleasure (Freud, 1955). One suspects that the term might occasionally have been used as a convenient get-out clause for therapeutic failure (Webster, 1995, p. 152), but that would not undermine its potential explanatory value.

  Investigators have subsequently identified the kind of brain processes that trigger such behaviour. A feature of trauma is a high level of brain arousal. Immediately following exposure to trauma, there are consequences that can assume positive motivational qualities. That is to say, high arousal is followed by behavioural calming (Apter, 2007). This sequence sounds remarkably like one aspect of a conventional reinforcing sexual interaction.

  Natural opioids are released under conditions of stress and going back into a similar situation appears again to trigger opioid release, in some cases followed by withdrawal symptoms when the effect wears off. Drugs, such as heroin and morphine, that mimic natural opioids, cause motivation to be directed towards repeating the drug experience. It appears that stress-induced opioid release can have a somewhat similar effect in triggering a repeat of the stressful experience (van der Kolk, 1989). Evidence supportive of such an effect is that Vietnam War veterans rep
orted feeling less physical pain when they were allowed to view a movie about the war. This had a similar pain-relieving effect to a shot of 8 mg of morphine. Shipman might have recreated an opioid-based mood change by his murders.

  The phenomenon of the abused becoming the abuser says something about reinforcement, classical and instrumental conditioning. To a considerable extent, experiences that were hedonically positive become reinforcers and form associations with neutral stimuli. However, Skinner and his followers pointed out that positive reinforcement does not equate to hedonism in any simple way, and the phenomenon under discussion here illustrates this. Although the experiences of abuse would surely have been felt as aversive (Hogben and Byrne, 1998), nonetheless the individual is moved to repeat something similar.

  Excitation and inhibition

  As a general principle, sexual interaction, whether atypical or not, contains opposing elements (Chapter 12 and Bancroft, 2009). A behavioural activation system underlies appetitive behaviour, while a behavioural inhibition system tends to restrain behaviour. Inhibition arises from such things as fear of humiliation or possible harm to oneself. It is triggered by the detection of threats, such as cues predictive of aversive consequences.

  Some forms of paraphiliac behaviour meet with social disapproval, from mild mocking to severe punishment. Social exclusion, life in prison or even death can form the penalty for the most extreme. This would surely be enough to recruit sufficient inhibition to keep most of us on the straight and narrow, even if we felt any inclination to deviate. Where behaviour is atypical, especially of a socially unacceptable form, excitation might not necessarily be abnormally high but inhibition could be relatively under-active.

  Some individuals exhibit a range of different paraphilias (Abel and Rouleau, 1990; Meloy, 2000), so there might be a general deficit of inhibition rather than a multitude of different conflicts each specific to a given paraphilia. Engaging in one paraphilia might lower the inhibition on others. For a subgroup of paraphilias, Wolf (1988) remarked (p. 142):

  once a person is disinhibited to and aroused to one particular focus of sexually aggressive behaviour, it is significantly easier for them to acquire a second or third or fourth focus. This is much in the same manner that it would be easier for a skydiver to take up hang-gliding.

  Levels of control in the brain and brain chemicals

  Paraphilias are often troubling to those who suffer from them, even if only through the risk of capture, and these individuals often acknowledge the problem and at least consider, if not seek, medical help. This reveals a conflict for the control of behaviour, with a high level of restraint proving inadequate in the face of the pull of the lower-level controls triggered by incentives and their mental representation.

  The relative influence exerted by the low-level and high-level systems appears to be dependent upon the amount of the neurotransmitter serotonin in the brain (Carver et al., 2009). If this is decreased, control shifts in favour of the lower level, with a tendency for a person to behave more impulsively, to show a higher reaction to anger and a relatively high degree of sensation-seeking. They are more likely to be captured by the ‘cues of the moment’. Conversely, increasing the amount of serotonin is associated with greater conscientiousness and agreeableness. These qualities appear to require taking a more distant perspective in assessing priorities, rather than giving in to impulsiveness, suggesting a tilting in favour of higher-levels of control. There is evidence that drugs that boost the availability of serotonin in the brain are sometimes effective in treating a range of paraphilias (Masand, 1993), suggesting a strengthening of high-level controls. In addition, serotonin could act at the level of the nucleus accumbens to inhibit desire (Pfaus, 2009).

  Certain brain structures, for example the prefrontal cortex, that are particularly compromised by early abuse are newly evolved and late to develop fully (Gerhardt, 2004; Rich, 2006; Schore, 2003). These normally exert high-level inhibition on behaviour. Correspondingly, the low-level system takes a disproportionately large weight in the balance of control. Those exhibiting deviant sexuality reveal a rather high probability of having suffered early abuse or at least inadequate mother–child interaction.

  The closely-related notions of (a) excitation and inhibition and (b) levels of control appear to be central to understanding psychopathy, to which the discussion now turns.

  Psychopathy

  Some features of the psychopath

  The characteristic of ‘psychopathy’ does not necessarily link with deviant sexual desire but it sometimes does so in an alarming manner. Some general principles of psychopathy illuminate features of coercive sexual behaviour (Muñoz et al., 2011). As a defining feature, psychopaths are not insane and they exhibit rational decision-making. It is just a rather different rationality, which is based upon an alternative set of values and parameters, as compared to that of non-psychopaths (Hare, 1993). Psychopaths are not lacking in social understanding of the mind-set and intentions of other individuals; indeed, they can be very competent in exploiting flattery, charm, manipulation and lies to get their way (Muñoz et al., 2011), as exemplified by the serial killer Ted Bundy. They have a relatively shallow experience of fear and a weak bodily reaction to what would trigger a pounding heart and sweaty palms in most of us (Hare, 1993). Psychopaths are also often characterized by hypersexuality, in the form of early onset of sexual behaviour, promiscuity and high sexual risk-taking (Kastner and Sellbom, 2012). In an analysis congruent with that presented here, Bailey (2002) suggests that psychopaths have shifted the weight of control to a lower level.2

  The notions of narcissist and psychopath are linked and appear to be relevant to sexual coercion. Although not all narcissists are psychopaths, probably all psychopaths are narcissists. Narcissists are characterized by a particularly high arrogance, sense of self-importance and self-entitlement, accompanied by a willingness to exploit others to achieve their own ends while showing low empathy with their concerns (Bushman et al., 2003). Narcissists are likely to exhibit relatively high levels of aggression in response to ‘threatened egotism’, as in for example perceived insults.

  Some psychopaths tend to be more strongly weighted towards impulsive control than are non-psychopaths, showing little sensitivity to the future (Hare, 1993) and great difficulty in delaying gratification. However, for other psychopaths aggression tends to be measured and appropriate to the circumstances, which indicates retention of control (Raine, 2013). Psychopaths are very good at allocating undivided attention to a given task and thereby missing signals of danger.

  Hare (1993, p. 61) writes: ‘Psychopaths have an on-going and excessive need for excitement – they long to live in the fast lane or “on the edge”, where the action is.’ Breaking the rules can bring them up to a more desirable level of arousal, to a ‘high’. One psychopath described the experience of breaking out from prison as ‘better than sex’ (p. 62).

  Personality characteristics of psychopaths include a willingness to exploit manipulation and use aggression, irresponsibility and callousness, accompanied by a lack of guilt and remorse and other similar restraining emotions (Blair, 2006; Gao and Raine, 2010). Some psychopaths make primary use of so-called ‘instrumental aggression’ (‘cool’, planned aggression) to gain desired things, such as money, goods or sex. However, for other psychopaths, behaviour is biased towards so-called ‘reactive aggression’, which is impulsive, anger-related and can be triggered by frustration (Blair et al., 2006). Hence there is likely to be a heightened anger/aggression when such people are thwarted in attaining sexual goals, a tendency that could well be sensitized in cases where there has been a history of abuse when a child.

  The married psychopath can sometimes have a good life, particularly if his wife fits the traditional role (Hare, 1993). He can maintain an endless sequence of sexual adventures untroubled by remorse and yet have the security of the wife.

  A range of psychopathy

  The word ‘psychopath’ most likely creates an image of a seria
l killer lurking in the bushes to pounce on an unsuspecting victim. This represents just one extreme. At the milder end of the scale, traits of psychopathy are associated with such things as aggressive sexual coercion of a date partner and use of alcohol as a tool in sexual manipulation (Kosson et al., 1997). In some cases, women who fall on the psychopathy scale also exhibit some sexually coercive tactics (Muñoz et al., 2011). Not surprisingly, these are usually of milder degree than the male equivalents but include the common feature of getting a potential sex partner intoxicated.

  Excitation and inhibition as applied to psychopathic behaviour

  The notions of excitation, inhibition and disinhibition play a central role in understanding psychopathy and the associated reckless and coercive behaviour (Sewell, 1985; Wallace and Newman, 2008). In terms of behavioural activation, it appears that psychopaths have a relatively high sensitivity, this being triggered particularly by novelty (Kastner and Sellbom, 2012).

  For non-psychopaths, at the prospect of engaging in coercive sexual behaviour, there would be inhibitory factors of two rather different qualities:

  At an egocentric level, there would be fear of humiliation or capture or possible harm to oneself.